Table of Contents
International Scholarly Research Notices
Volume 2014, Article ID 479240, 4 pages
http://dx.doi.org/10.1155/2014/479240
Clinical Study

Transfusion-Dependent Anaemia: An Overlooked Complication of Paraoesophageal Hernias

Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia

Received 29 March 2014; Revised 25 May 2014; Accepted 2 June 2014; Published 24 July 2014

Academic Editor: Simon Ng

Copyright © 2014 Richard J. E. Skipworth et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. A paraoesophageal hernia (PH) may be one reason for iron-deficiency anaemia (IDA) but is often overlooked as a cause. We aimed to assess the incidence and resolution of transfusion-dependent IDA in patients presenting for hiatal hernia surgery. Methods. We analysed a prospective database of patients undergoing laparoscopic hiatal repair in order to identify patients with severe IDA requiring red cell/iron transfusion. Results. Of 138 patients with PH managed over a 4-year period, 7 patients (5.1%; M : F 2 : 5; median age 62 yrs (range 57–82)) with IDA requiring red cell/iron transfusion were identified. Preoperatively, 3/7 patients underwent repetitive and unnecessary diagnostic endoscopic investigations prior to surgery. Only 2/7 ever demonstrated gastric mucosal erosions (Cameron ulcers). All patients were cured from anaemia postoperatively. Discussion. PH is an important differential diagnosis in patients with IDA, even those with marked anaemia and no endoscopically identifiable mucosal lesions. Early recognition can avoid unnecessary additional diagnostic endoscopies. Laparoscopic repair is associated with low morbidity and results in resolution of anaemia.